Noteworthy News Articles on Mental Health Topics, June 1-9, 2006
What Can Be Done in the Name of Obedience
Alessandra Stanley, New York Times- 6/1/2006
People wonder how ordinary American soldiers, men and women, could have mistreated prisoners so barbarically at Abu Ghraib. "The Human Behavior Experiments," a documentary on both Court TV and the Sundance Channel tonight, suggests that actually it's surprising such things don't happen more often.
Dr. Stanley Milgram's infamous "electroshock" experiments at Yale in the 1960's revealed just how banal the banality of evil is. "Human Behavior" shows black-and-white clips from those studies, and also reports on other, even more disturbing, experiments.
The fragility of human kindness and common sense was exposed again in 1971 by Dr. Philip G. Zimbardo, a social psychologist at Stanford who recruited a group of undergraduate men to play guards and prisoners in a simulated prison. In less than a week many of the guards had of their own accord turned sadistic, while prisoners grew anxious and disturbed. Some of the photographs from that study are eerily similar to the Abu Ghraib snapshots: naked prisoners posed in sexually humiliating positions with bags over their heads.
But the most alarming scenes of all were caught by a surveillance camera in the back office of a McDonald's restaurant in Mt. Washington, Ky., in 2004. A prankster posing as a police officer — over the telephone — instructed an assistant manager, Donna Jean Summers, to strip-search a teenage employee the imposter said was a thief; by the end of the evening the caller had also persuaded Ms. Summers' fiancé to abuse the employee and force her to perform oral sex. Most shocking of all, at least 70 other people in fast food restaurants were duped into committing other kinds of offenses. "Unless you are put in that situation at that time, how do you know what you would do?" Ms. Summers said in an interview. "You don't."
Many news articles and documentaries have tried to analyze what went wrong at Abu Ghraib. Most concluded that ill-trained soldiers were under enormous pressure to set the kind of conditions that would best extract information from prisoners, but without clear guidelines on how. "Human Behavior," written and produced by Alex Gibney, who also made "Enron: The Smartest Guys in the Room," fills in some of the psychological blanks by illustrating how, in certain circumstances, people readily obey even far-fetched instructions. Most of all, the film shows how easily people lose perspective and basic decency when in the grip of a credible authority figure or even just a difficult group dynamic.
Old film taken from interviews with Dr. Milgram, who died in 1984, reveal a mild, slightly pedantic man with big glasses and a chin beard, who explains that the Holocaust made him want to understand better how it was possible for ordinary people to act "callously and inhumanely." He set out to study authority and explore, as he put it, "under what conditions could a person obey, when commanded, actions that went against conscience." He devised a study in which subjects delivered what they thought were painful electric jolts to a fellow participant, merely because they were encouraged to do so by the scientist in charge who assured them it was necessary for a learning experiment. The film shows one middle-aged man balking after hearing what he thinks is the subject howling in pain (in reality it is a recording), but many more — about 60 percent — keep increasing the pain levels under calm but firm instruction from the experimenter, "Continue, please."
Dr. Zimbardo's prison study was even more shocking, if only because the students assigned to play guards were not instructed to be abusive, and instead conformed to their own notions of how to keep order in a prison: "Lord of the Flies" in sideburns and aviator sunglasses. The prisoners were blindfolded, stripped, assigned numbers and forced to wear skimpy hospital gowns and ankle chains. The guards were given handcuffs, whistles and billy clubs. The scientists received a shocking display of how, as one of them put it, "human nature transformed in a very rapid way in the face of a very powerful situation." The abuse kept escalating until, on the fourth day, it turned into sexual humiliation. Prisoners began breaking down. Dr. Zimbardo and his team were so engrossed by the experiment that they too lost sight of reality. In the film Dr. Zimbardo recalls that it was not until his girlfriend visited the mock prison and threatened to break up with him that he snapped out of it and ended the study early.
The Stanford students knew they were taking part in a psychology experiment. Soldiers assigned to guard prisoners at Abu Ghraib were told that the survival of comrades on the front lines depended on whether they could break the prisoners. Dr. Zimbardo, who in 2004 served as an expert witness in the court martial of Staff Sgt. Ivan Frederick II, who was convicted of assault, indecent acts and dereliction of duty at Abu Ghraib, said he was "an ordinary good guy who gets into this place and is totally corrupted."
The documentary uses several cases, from the 1964 murder of Kitty Genovese, when 38 neighbors in Queens heard or saw parts of the fatal attack and did nothing, to a 2005 hazing ritual that killed Matthew Carrington, a 21-year-old student at California State University, Chico, to make a point about herd mentality: that people who might give help when by themselves will, among others, hold back and follow the cues of a majority. The person who goes against the group or defies authority is a rarity. "It is the majority who conform, who comply, who obey authority," Dr. Zimbardo says. "And that's what nobody wants to hear." That rule is certainly something most people prefer to forget. "Human Behavior" is a riveting, if unsettling reminder.
Judging Whether a Killer Is Sane Enough to Die
Ralph Blumenthal, New York Times- 6/2/2006
HOUSTON— Scott Panetti, a death row inmate in Texas, understands that the state says it intends to execute him for the murder of his wife's parents. But Mr. Panetti, 48, who represented himself in court despite a long and colorful history of mental illness, says he believes that the state's real reason is a different one. He says the state, in league with Satan, wants to kill him to keep him from preaching the Gospel. That delusion has been documented by doctors and acknowledged by judges and prosecutors. It poses what experts call the next big question in death penalty law now that the Supreme Court has barred the execution of juvenile offenders and the mentally retarded: what makes someone too mentally ill to be executed? A three-judge panel of the United States Court of Appeals for the Fifth Circuit, in New Orleans, recently said Mr. Panetti was sane enough to die. The full court will soon decide whether to hear the case.
Mr. Panetti, in prison now almost 14 years for the killings in 1992 in the quaint Hill Country city of Fredericksburg, has long seemed to exemplify madness, addressing himself to the jury in his trial in 1995 as "the born-again April Fool," a schizophrenic healed by God. In and out of mental institutions 14 times and addicted to drugs and alcohol since he almost drowned as a child and was nearly electrocuted by a power line, Mr. Panetti wore cowboy costumes to court, delivered rambling monologues, put himself on the witness stand and sought to subpoena the pope, Jesus and John F. Kennedy.
Jurors were clearly alienated and took little more than an hour to reject his insanity defense. They found that Mr. Panetti knew right from wrong and so deserved the death penalty. That is a separate question from whether his mental illness should bar his execution.
Two decades ago, the United States Supreme Court in Ford v. Wainwright ruled that the Eighth Amendment prohibited the execution of the insane. Since then, lower courts have struggled to find a way to apply that principle in practice. The state and federal courts that have heard Mr. Panetti's case have said that a bare awareness of the fact of impending execution and the stated reason for it is enough. "In Texas," said Greg Wiercioch, a lawyer with the Texas Defender Service who has consulted with Mr. Panetti's defense, "if you cast a shadow on a sunny day, you're competent to be executed." Other courts require more. Relying on a concurring opinion in the Supreme Court decision, they say the inmate actually has to perceive the connection between the crime and the punishment.
The three-judge panel in Mr. Panetti's case acknowledged that he was mentally ill with what has been diagnosed as schizoaffective disorder and that he thus might lack a rational understanding of his fate. But the panel nonetheless ruled that he was competent to be executed because he was able to understand the stated basis for his execution. His new lawyers dispute that. "He completely scoffs at the notion that it's the State of Texas trying to execute him," said Keith Hampton, a lawyer from Austin who filed the latest appeal with a co-counsel, Michael C. Gross of San Antonio. "He thinks it's the demons and evil ones."
Legal and medical experts estimate that hundreds of people with schizophrenia and other severe mental illnesses are on death rows around the nation. Courts have spared the lives of seven inmates based on the 1986 decision, the Texas Defender Service said. David R. Dow, a law professor at the University of Houston who has met more than 75 death row inmates, visited Mr. Panetti at his lawyers' request. "Of all the people I have met on death row, he's the gold-medal-crazy winner," Professor Dow said.
On Sept. 8, 1992, Mr. Panetti broke into the home of his in-laws, Joe and Amanda Alvarado, and shot them to death in front of his estranged second wife, Sonja, and his 3-year-old daughter, Amanda, known as Birdie. Taking on his defense, and calling himself as a witness, he argued that he had been taken over by an alter ego he called Sarge Ironhorse. "Sarge boom boom," Mr. Panetti testified. "Sarge is gone. No more Sarge. Sonja and Birdie. Joe, Amanda lying kitchen, here, there blood. No, leave. Scott, remember exactly what Sarge did. Shot the lock. Walked in the kitchen. Sonja, where's Birdie? Sonja here."
Prosecutors, their medical experts and the courts agreed that Mr. Panetti suffers from mental illness. Judge Sam Sparks of Federal District Court in Austin found in 2004 that Mr. Panetti's illness was characterized by "grandiosity and a delusional belief system in which he believes himself to be persecuted for his religious activities and beliefs." Judge Sparks said that was not enough to spare Mr. Panetti. Others agree.
Robert Blecker, a law professor at the New York Law School and a cautious supporter of the death penalty, said Mr. Panetti's execution could serve the goal of retribution. "He knows what he did," Professor Blecker said. "He knows what the state is about to do to him, and why. For the retributivist, the past counts. It counts for us, and for us to be retributively satisfied, it must also count for him." Prosecutors made the same point in a brief to the Fifth Circuit last year. "All that is required to avoid the Eighth Amendment prohibition against cruel and unusual punishment is that the petitioner factually understand the reason for this punishment," the prosecutors wrote.
Executions of inmates who exhibited signs of madness are not unusual. In 1992, Arkansas executed Ricky Ray Rector not long after he put aside the dessert of his last meal to eat later. In March, the United States Court of Appeals for the Fourth Circuit, in Richmond, Va., split, 7 to 6, over whether Percy L. Walton could be executed, notwithstanding his delusional belief that after his death he would "come back as a better person" and "get a Burger King." A majority said this was proof that Mr. Walton understood he would be executed. "That a person believes that he will have an 'afterlife,' however strange his views of that 'afterlife' may be," Judge Dennis W. Shedd wrote, "necessarily suggests he believes his existing life will end."
The laws of most states, based on English common law, have long banned the execution of the insane. "The reasons for the rule are less sure and less uniform than the rule itself," Justice Thurgood Marshall wrote in the 1986 case. Some judges say the "miserable spectacle" of such executions simply offends humanity. Others say retribution is not served by executing someone who cannot understand why he is being put to death. Still others point to the inability of the insane to assist their lawyers in last-minute litigation. In the Middle Ages, it was thought that madness was its own punishment.
Mr. Hampton, who filed the latest appeals brief, said that from the trial on he was revolted by the Panetti case. "I thought there was no way, no way, no matter how bad things in the state of Texas got, that it would allow someone in the full flower of schizophrenia to represent himself," he said. But in repeatedly calling himself insane — "I went nuts," Mr. Panetti told the police officers after the killings, "well, I am nuts" — Mr. Panetti seemed to have run into his own Catch-22, leaving jurors skeptical of anyone so eager to establish his insanity. Now the courts, taking one last look at Mr. Panetti, must decide whether he is sane enough to die.
Addicts Rally for Better Access to Treatment Drug
Scott Allen, Boston Globe- 6/3/2006
With heroin and OxyContin abuse at epidemic levels, Massachusetts doctors say they are increasingly frustrated by tight federal restrictions that force them to put addicts on a waiting list for the most promising treatment for opiate addiction in decades.
Suboxone is the first treatment for addiction to heroin and narcotic pain relievers that doctors can prescribe rather than sending patients to a methadone clinic, making it more attractive for younger addicts and addicts who hold jobs and other responsibilities. Suboxone can be taken at home, and , unlike methadone, it doesn't make patients groggy and there is little risk of a fatal overdose.
But Congress allows doctors to treat no more than 30 addicts at a time with the somewhat addictive drug, and only after they've completed an eight-hour course. In Massachusetts, 425 doctors are approved by the US Drug Enforcement Administration to prescribe Suboxone, barely enough physicians to prescribe the drug to all the heroin addicts in the Boston area alone. Doctors in other states have reported waiting lists for the drug of up to 300 addicts, while some Massachusetts doctors say they have stopped counting how many patients they turn away.
``This medication has the potential to wipe out at least 50 percent of the national demand for heroin," said Dr. Claude Curran , a Fall River psychiatrist who defied the federal limit last year. Curran prescribed Suboxone to 800 patients before the DEA forced him to dramatically scale back by transferring patients to other doctors or terminating their treatment.
Curran plans to lead a protest at the JFK Federal Building in Boston this afternoon , bringing together addicts, their families, and treatment providers to rally support for a measure just introduced in the US Senate to allow at least some doctors to treat far more than the current limit.
However, state officials caution that relaxing limits on prescriptions of Suboxone could cause problems. While Suboxone is less dangerous than methadone -- implicated in more than 1,100 deaths since 1970 -- it is also less effective for hardcore addicts. And, just three years after it went on the market, the US Justice Department reports a black market for the drug, which is potent enough to get non-opioid addicts high.
``We've got to be careful that this is done in a thoughtful manner," said Michael Botticelli , the assistant public health commissioner of the state Bureau of Substance Abuse Services. ``It's important that this not become a pill factory [or] a cash cow for physicians who want to make money" from the opiate epidemic.
Up to a million people nationwide are addicted to heroin and 4.4 million people abuse narcotic pain relievers such as OxyContin. Both drugs are chemically related to opium and can create a powerful craving for more. Only about 15 percent of addicts who go ``cold turkey" are still drug-free a year after they get out of detox, according to Dr. Mark Eisenberg of Massachusetts General Hospital.
Since 1973, methadone has been the main long-term treatment for opiate addicts, giving them a daily high that temporarily eases their craving for opiates. But the rise of cheap heroin and abuse of pain relievers created new classes of addicts from experimenting 20-somethings to middle-aged working people who got hooked after taking pain pills for an injury. These patients didn't want to go to a clinic for care and they feared methadone's side effects.
Suboxone, also known as buprenorphine , seemed to offer a real alternative when approved in 2002, and addicts raved that the new drug controlled their cravings without dulling their minds.
``I said, `Wow. I want this forever,' " said Barry Andrade , who took the medicine in the early 1990s as part of a study. ``I was functional. I was working. I was married. I was paying my bills."
When the study ended, he recalls, he went back to heroin and was jailed repeatedly for drug offenses until he began taking buprenorphine again recently. Andrade said he searched for years for a doctor who could prescribe it to him before finding Curran.
Though 9,200 doctors nationwide are now authorized to prescribe Suboxone, the limit of 30 addicts per doctor makes it virtually impossible to treat most of the people who need help, said Dr. Karen Kagey of Medway, who plans to attend the rally. ``I turn down eight or 10 people per month at least, sometimes more," she said. ``Some of them say they have called 50 or 60 doctors."
Study Links Spirituality to Lower Blood Pressure
Carolyn Susman, Cox News Service- 6/3/2006
NEW YORK - Even when you don't pray for health, prayer may do a body good. A study of more than 5,000 African Americans shocked .many of those attending the American Society of Hypertension, even the researchers who presented the findings, when it concluded that blood pressure was lower among those who devoted themselves to spirituality. Praying and meditation didn't prevent blood pressure from rising - in fact, those who were most involved in religious activities had hypertension -- but they had lower readings than others with hypertension who didn't make spirituality an active part of their lives.
No one was more confounded by this positive link than study author Dr. Sharon Wyatt, from the University of Mississippi Medical Center in Jackson, Miss. "We don't recommend a prescription of religion," Wyatt said. "But it's an important part of life for these people." '
The amazing part of these findings is that many of those with the lower readings were overweight and didn't always take their medications. This was totally counter to the initial assumption that Wyatt and her coauthor had expected. That is, that those who engaged in religious activities would be more likely to have high blood pressure. Instead, they found that spirituality seemed to give a protective buffer to those whose health practices otherwise would seem to put them at very high risk. The factors most prominent here, she expects, are levels of cortisol, the stress hormone. Those levels seemed to be less in those going to religious services and regularly engaging in prayer and meditation. Maybe, Dr. Wyatt theorized, it's because people of such faith think "God will take care of it," and that becomes a stress reducer. Using spirituality in your life is different from having others pray for you -- known as intercessory or remote prayer -- which has been the topic of several clinical studies.
A British study in 2001 concluded, "Remote, retroactive intercessory prayer said for a group is associated with a shorter stay in hospital and shorter duration of fever in patients with a bloodstream infection and should be considered for use in clinical practice." A larger study published last year found that, "Distant prayer and the bedside use of music, imagery and touch did not have a significant effect upon the primary clinical outcome observed in patients undergoing certain heart procedures." One concern is that people who are overweight and not taking medications to control blood pressure might interpret Wyatt's findings as a go-ahead to continue that behavior.
Heroin Users Warned About Deadly Additive
Peter Slevin, Washington Post- 6/4/2006
CHICAGO -- The largest clue that something had changed in Chicago's vibrant heroin market came in February, when police found a dozen users sprawled unconscious in one place. One day in April, there were dozens more. Toxicologists at the Cook County morgue discovered fentanyl, a powerful painkiller many times stronger than morphine, in the bodies of addicts who died. A small amount of fentanyl in a dose of heroin adds a pop that many users have come to crave. "It's a new phenomenon. It's the latest high," said Chicago police spokeswoman Monique Bond, "but it's deadly. "
Since February, coroners have recorded 55 fentanyl-related deaths in Cook County, with 45 more cases suspected. Some were unsuspecting users taking pure fentanyl; others were users taking a mixture. Scores overdosed but recovered -- and not all regretted using it. "There's this consumer arc. At first there's fear, but then when the fear is over, it's like: Hey, that's good stuff," said Greg Scott, a DePaul University sociologist who conducts government-funded research on injected drugs. "Most so-called street addicts can't afford more than what they're already doing, so fentanyl gives you that little extra bump. People are scouting for it."
Authorities have spotted the practice in Pennsylvania and New Jersey, and it appears most serious in Detroit, where authorities suspect that more than 175 people have died in recent months from fentanyl-related overdoses. The national Centers for Disease Control and Prevention is investigating. Federal and local authorities are convening a workshop in Chicago next week to learn more. "It's baptism by fire here," Scott said.
The Chicago Recovery Alliance runs a weekly needle exchange and barbecue in a bus parking lot in Cicero, just outside city boundaries. At recent sessions, the organization has been warning users about the dangers and teaching them how to distinguish the mint green-tinged fentanyl-laced heroin from the typical Chicago drug, which tends to be yellowish or dusty brown. "We tell them: If it's green, you shouldn't use it," said Cheryl Hull, the group's deputy director of operations, who reported that at least seven clients have died. Staffers have been urging users to be far more vigilant and to get high in twos or threes, never alone.
Cathy Piotrowski, who showed up for last week's barbecue, said she has overdosed four times on a fentanyl-heroin mix. "You do it, then bam, you're just right out. You don't remember anything," said Piotrowski, 42, who reported taking three hits of heroin a day. "I'm warning people about it, saying this stuff is going around, so be careful."
Despite the obvious dangers, the quest for a bigger and better high is driving users to find the more potent fentanyl-heroin blend. Universal laws of marketing and sales are similarly driving the pushers to supply it, authorities said. Even the police unwittingly contributed to the phenomenon. "The dealers were passing out free samples to attract users," police spokeswoman Bond said. "The police department was trying to be proactive by alerting the public about the bad heroin, but we were providing free marketing, basically providing a road map."
Scott, the DePaul sociologist, said four of the five heroin-dealing crews he is tracking are now selling the drug laced with fentanyl. They sell more dope in what is a competitive market, he said, and make more money. The users, especially those who can afford only a limited amount of heroin even as their tolerance grows through habitual use, see a way to get higher. "For the same amount of money, you can get a product that's, let's say, 10 times more potent," Scott said.
Frankie is a 43-year-old homeless man who did not want to give his last name. He said he overdosed late last month on fentanyl-laced heroin he got for free on Chicago's Southwest Side. Police took him to the hospital. A former amateur boxer, he likened the effect to being slugged in the head and knocked out. To him, the freebies did not make much sense. "They were handing it out," he said, "but why kill your new customers?"
In a Crisis, They Offered Something, Anything
Elissa Ely, M.D., New York Times- 6/6/2006
She was thinking of throwing herself in front of traffic. The day program had sent her over with her lunch in a bag, as if she were on a field trip instead of being there for a crisis evaluation. All morning she had been coming apart, and told us so in her own tongue. "I'm up and down, up and down, like the sun going in and out, in and out," she said, the lunch dangling out of her shoulder bag, unnoticed. "I'm losing my luster and my equilibrium."
Equilibrium was something she had never known, actually. When she was a child, her mother had pushed her out of a speeding car. In adolescence, foster families had pushed her from one home to another. Medical illnesses had unbalanced her in adulthood. She tried to compensate with a deliberately sunny disposition. My office was full of drawings of flowers with pert pistil noses, houses with happy expressions in their window eyes, trees with beaming trunks.
Then, for no particular reason — maybe a disagreement in the group home or a bad morning in the program — she would become possessed. Real and psychotic tragedies from the past and present became mixed up. The next thing she knew, she saw speeding cars, saw herself jumping in front of one this time, instead of being pushed out. Her urges grew stronger, and she had acted on them in the past. The day program, recognizing her agitation, would pack her lunch to go.
Now she sat in the office, rocking and panting. She grabbed one of my hands and one of the therapist's hands. She closed her eyes. "Let's pray," she said loudly. "Oh Lord, send Dr. Ely magical powers from my ring. Give me the courage to battle the demon in my room. Run, run, run." She opened her eyes for a second. "Look at what shock therapy did for Frankenstein," she said. "If it did that for him, imagine what it could do for a whole person." She started to cry.
The therapist and I looked at each other. She was descending into hysteria, unraveling in front of us, and frankly, it wasn't clear what to do. The lunch dangled from her shoulder bag. "Where are my manners?" the therapist said. "You should eat a little." He might have been stalling, but he is a practical person and it was past noon. He pushed aside the charts on my desk, took the plastic foam box out of her lunch bag and lifted the lid. Inside were fists of mashed potatoes, chicken with gravy, green beans, a wheat roll. He put the box on my desk and handed her the fork that had come with it.
She was not quite close enough to the desk for a polite meal. Gravy fell on billing forms and dripped to the floor. A bit of potato hung from her mouth and green beans dropped on my appointment cards. She scooped them up and ate. As she ate, she made little noises. The longing noises of infant and thumb reunited. The appraising noises of a connoisseur swirling Bordeaux in a glass. Finally, the appreciative, content noises of a good meal well finished. Her face softened. Her breathing slowed. Luster and equilibrium were returning. "You were starving there," the therapist said. Rocking only a little, she replied, "I guess I was." "Feeling better?" "I guess I am." "Think you might need a hospital?" She sighed and thought. She had a complacent look now; the crisis was past. Her illness was complicated, but she was seeing the future. "There's a cooking group tomorrow at the program," she said. "We're making pie crust."
An old teacher of mine once advised: in a crisis, offer something — anything. Talking it over afterward, awed by the force of her response, we theorized that maybe the loving mother she had never known would have done the same thing under these circumstances. Starvation was the metaphor for her brave life. The therapist said, "Or maybe she was hungry."
Use of Antipsychotics by the Young Rose Fivefold
Benedict Carey, New York Times- 6/6/2006
The use of potent antipsychotic drugs to treat children and adolescents for problems like aggression and mood swings increased more than fivefold from 1993 to 2002, researchers reported yesterday. The researchers, who analyzed data from a national survey of doctors' office visits, found that antipsychotic medications were prescribed to 1,438 per 100,000 children and adolescents in 2002, up from 275 per 100,000 in the two-year period from 1993 to 1995. The findings augment earlier studies that have documented a sharp rise over the last decade in the prescription of psychiatric drugs for children, including antipsychotics, stimulants like Ritalin and antidepressants, whose sales have slipped only recently. But the new study is the most comprehensive to examine the increase in prescriptions for antipsychotics.
The explosion in the use of drugs, some experts said, can be traced in part to the growing number of children and adolescents whose problems are given psychiatric labels once reserved for adults and to doctors' increasing comfort with a newer generation of drugs for psychosis. Shrinking access to long-term psychotherapy and hospital care may also play a role, the experts said.
The findings, published yesterday in Archives of General Psychiatry, are likely to inflame a continuing debate about the risks of using psychiatric medication in children. In recent years, antidepressants have been linked to an increase in suicidal thinking or behavior in some minors, and reports have suggested that stimulant drugs like Ritalin may exacerbate underlying heart problems. Antipsychotic drugs also carry risks: Researchers have found that many of the drugs can cause rapid weight gain and blood lipid changes that increase the risk of diabetes. None of the most commonly prescribed antipsychotics is approved for use in children, although doctors can prescribe any medication that has been approved for use.
Experts said that little was known about the use of antipsychotics in minors: only a handful of small studies have been done in children and adolescents. "We are using these medications and don't know how they work, if they work, or at what cost," said Dr. John March, a professor of child and adolescent psychiatry at Duke University. "It amounts to a huge experiment with the lives of American kids, and what it tells us is that we've got to do something other than we're doing now" to assess the drugs' overall impact.
But many child psychiatrists say that antipsychotic medication is the best therapy available for children in urgent need of help who do not respond well to other treatments. Without them, they say, many unpredictable, emotionally unstable children would end up institutionalized. Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University and the lead author of the study, financed in part by the National Institute of Mental Health, said the popularity of antipsychotic drugs might result in part from "the fact that psychiatrists have few other pharmacological options in certain patients." The study, which looked at visits to pediatricians and other doctors, found that psychiatrists were the most likely to prescribe antipsychotic drugs. In light of how little these drugs have been studied in children, Dr. Olfson said, "to me the most striking thing was that nearly one in five psychiatric visits for young people included a prescription for antipsychotics."
The Columbia investigators analyzed data from the National Center for Health Statistics survey of office visits, which focuses on doctors in private or group practices. They calculated the number of visits in which an antipsychotic drug was prescribed to people under the age of 21 and collected information on patients' medical histories. The total number of visits that resulted in prescriptions for the drugs increased to 1,224,000 in 2002 from 201,000 1993 to 1995.
The researchers attributed some of the increase to the availability of a new class of drugs for psychosis, called atypical antipsychotics, that were introduced in the early and mid-1990's. The newer drugs, heavily marketed by their makers, were attractive in part because they appeared less likely than older types of antipsychotics to cause side effects like tardive dyskinesia, a neurological movement disorder similar to Parkinson's disease.
From 2000 to 2002, the new study found, more than 90 percent of the prescriptions analyzed were for the newer medications, and most of the patients were boys, predominantly Caucasian children, who were significantly more likely to see psychiatrists than other ethnic groups. Some experts also pointed to an increase in the diagnosis of bipolar disorder in children as a contributing factor. In recent years, psychiatrists have begun to diagnose the disorder in extremely agitated, often aggressive children with mood swings — short surges of grandiosity or irritation that alternate with periods of despair. These symptoms in children are thought to be related to the classic euphoria and depressions of adult bipolar disorder. At the same time, several of the atypical antipsychotics, including Risperdal from Janssen and Zyprexa from Eli Lilly, won approval for the treatment of mania in adults. Some psychiatrists now routinely prescribe atypical antipsychotics "off label" for young people thought to have bipolar disorder, and researchers have begun to study the drugs in children as young as preschool age.
In the new study, about a third of the children who received antipsychotics had behavior disorders, which included attention deficit problems; a third had psychotic symptoms or developmental problems; and another third were suffering from mood disorders. Over all, more than 40 percent of the children were also taking at least one other psychiatric medication.
"We feel the medications are effective in children with bipolar and have some data to show that," said Dr. Melissa DelBello, an associate professor of psychiatry at the University of Cincinnati, who has done several studies of the drugs. Dr. DelBello said that the field "desperately needs more research" to clarify the effects of the antipsychotic drugs but that many children struggling with bipolar disorder got more symptom relief on these drugs than on others, allowing psychiatrists to cut down on the overall number of medications a child is taking.
Lisa Pedersen of Dallas, the mother of a 17-year-old boy being treated for bipolar disorder, said he was unpredictable, hostile and suicidal before psychiatrists found an effective cocktail of drugs, which includes a daily dose of antipsychotic medication. "Believe me, I would never choose having him on these meds," Ms. Pedersen said in a telephone interview. "It's not fun watching a child deal with the side effects. But finding the right combination of medicine has made his life worth living." Yet this process is one of trial and error for many children. Ms. Pedersen said her son had responded badly to the first two antipsychotic drugs he received. And some experts think the way that psychiatric drugs are prescribed is obscuring any understanding of underlying disorders and the optimal treatments.
"If you're going to put children on three or four different drugs, now you've got a potpourri of target symptoms and side effects," said Dr. Julie Magno Zito, an associate professor of pharmacy and medicine at the University of Maryland. Dr. Zito added, "How do you even know who the kid is anymore?"
Patrick Kennedy Is 'Better' After Treating Dependency
John Holusha, New York Times- 6/5/2006
Representative Patrick J. Kennedy said yesterday that he felt much better after almost a month's treatment in the Mayo Clinic for drug dependency, and that he was looking forward to resuming his duties. But he said that he continued to suffer from bipolar disorder and a tendency toward addiction, and will need help from a support group to avoid a relapse. "The key to recovery will be a small group of people who will watch over me," he said at a televised news conference.
Mr. Kennedy said, as he has before, that he had not been drinking before an early-morning car accident near the Capitol in Washington on May 4, even though the police on the scene said he appeared to be intoxicated. Mr. Kennedy said the police had canvassed bars in the District of Columbia seeking evidence of his drinking but were unable to find any. Rather, he said, he was under the influence of prescription antinausea and sleep medications, which he had taken at the "prescribed amount."
The question-and-answer session came after Mr. Kennedy, Democrat of Rhode Island, helped to open a conference on the future of mental health care and addiction treatment at Brown University in Providence. "I can tell you today, I feel confident of my health," he said at the health conference, adding that he was "positive about my future." He was discharged from the clinic, in Rochester, Minn., on Friday and spent the weekend with relatives in Washington before returning to Rhode Island on Sunday night. His private medical insurance policy paid for the stay in the clinic, he said.
The event was Mr. Kennedy's first public appearance since checking himself into the clinic on May 5, the day after the auto accident. Mr. Kennedy has said he has no memory of the crash or of his subsequent encounter with the Capitol Police, who charged him with three traffic violations. Mr. Kennedy, the son of Senator Edward M. Kennedy, put his drug taking in the larger context of mental illness. "I didn't know how miserable I was until I started to be feeling better," he said of his time at the clinic.
A Central Park Victim Recalls Her Healing
Anemona Hartocollis, New York Times- 6/8/2006
On an album of bittersweet children's songs that she wrote more than a decade ago, the woman who came to be known only as "the piano teacher" offered what, in hindsight, seems like an eerie glimpse of her own future. "I'm moving away today to a place so far away, where nobody knows my name," she wrote in the lyrics of a song called "Moving." When she wrote that song, she was young and vivacious, a piano teacher and freelance music writer who loved Beethoven and jazz, sunsets and river sounds, long walks and everything about New York.
On one of those beloved walks, through Central Park in the bright sun of a June day in 1996, a homeless drifter beat her and tried to rape her, leaving her clinging to life. After the attack, the words to her song came true. She "moved away," out of New York City, out of her old life, and all but her closest friends did not know her name. To the rest of the world, she was — like the more famous jogger attacked in Central Park seven years earlier — an anonymous symbol of an urban nightmare. She was "the piano teacher."
Now, on the 10th anniversary of the attack, she is celebrating what seems to be her full recovery from brain trauma. She is 42, married, with a small child. She is Kyle Kevorkian McCann, the piano teacher, and she wants to tell her story, her way. Her doctor told her it would take 10 years to recover, and Sunday was that talismanic anniversary. "I feel my life has been redefined by Central Park," she said several days ago, her voice soft and hopeful. "Before park; after park. Will there ever be a time when I don't think, 'Oh, this is the 10th anniversary, the 11th anniversary'?"
She spoke in her modest ranch house in a wooded subdivision in a New York suburb. She sat in a dining room strewn with toys, surrounded by photographs of her cherubic, dark-haired 2-year-old daughter. A Steinway grand filled half the room, and at one point she sat down and played. Her playing was forceful, but she seemed embarrassed to play more than a few bars, and shrugged, rather than answering, when asked the name of the piece. She asked that her daughter and her town not be named. She calls that day, June 4, 1996, the day "when I was hurt."
Hers was the first in a string of attacks by the same man on four women over eight days. The last victim, Evelyn Alvarez, 65, was beaten to death as she opened her Park Avenue dry-cleaning shop, and ultimately, the assailant, John J. Royster, was convicted of murder and sentenced to life in prison. Yet the attack on the piano teacher is the one people seem to remember the most. Part of the fascination has to do with echoes of the 1989 attack on the Central Park jogger. But it also frightened people in a way the attack on the jogger did not because its circumstances were so mundane. It did not take place in a remote part of the park late at night, but near a popular playground at 3 in the afternoon. It could have happened to anyone. The tension was heightened by the mystery of the piano teacher's identity.
For three days, as police and doctors tried to find out who she was, she lay in a coma in her hospital bed, anonymous. Her parents were on vacation and her boyfriend, also a musician, was in Europe, on tour. Finally, one of her students recognized a police sketch and was able to identify her in the hospital by her fingers, because her face was swollen beyond recognition. The police did not release her name.
The last thing she remembers about June 4, 1996, is giving a lesson in her studio apartment on West 57th Street, then putting her long hair in a ponytail and going out for a walk. She does not remember the attack, although she has heard the accounts of the police and prosecutors. "To me it's like a fact I learned and memorized," she said. "As if I were a student in school studying history." She does not think about the man who did it. "I might have been angry for a moment, but not much longer than that," she said. "How could I be angry at John Royster? He was declared not insane, but I guess by our standards he was."
Dr. Jamshid Ghajar, her doctor at New York Hospital-Cornell Medical Center, as it was known in 1996, told reporters that she had a 10 percent chance of survival. Doctors had to remove her forehead bone, which was later replaced, to make room for her swelling brain. When her mother made a public appeal to "pray for my daughter," thousands did. After eight days, she came out of a coma, first in a vegetative state, then in a childlike state. As she recovered, she slept little and talked constantly, sometimes in gibberish. "I was getting mad at people when they didn't respond to these words," she said.
Like an Alzheimer's patient, she had little short-term memory and would forget visitors as soon as they left the room. Over several months, she had to relearn how to walk, dress, read and write. Her boyfriend, Tony Scherr, visited every day to play guitar for her. He encouraged her to play the piano, against the advice of her physical therapists, who thought she would be frustrated by her inability to play the way she once had. Mr. Scherr played Beatles duets with her, playing the left-hand part while she played the right. "That was my best therapy," she said.
In August, she moved back home to New Jersey, with her father, an engineer, and mother, a schoolteacher. She visited old haunts and called friends, trying to restore her shattered memory. "I was very obsessed with remembering," she said. "Any memory loss was to me a sign of abnormality or deficit." Her therapists thought her progress was terrific, but her two sisters protested that she was not the deep thinker she had been.
What bothered her most was that she had lost the ability to cry, as if a faucet inside her brain had been turned off. One night, nine months after she was hurt, she stayed up late to watch the John Grisham movie "A Time to Kill." Just after her father had gone to bed, she watched a courtroom scene of Samuel Jackson's character on trial for killing two men who had raped his young daughter. The faucet opened, and the tears trickled down her cheeks. "I thought about my parents, my father, and what they went through," she said. "Little by little, my feeling returned, my depth of mind returned." Urged by her sisters, she went back to school and got a master's degree in music education.
Not everything went well. She and Mr. Scherr split up five years after the attack, though they remain friends. She dated other men, but she always told them about the attack right away — she could not help it, she said — and they never called for a second date. "We have to find you someone," her friend David Phelps, a guitar player, said four years ago, before introducing her to Liam McCann, a computer technician and amateur drummer. For once, she did not say anything about the attack until she got to know Mr. McCann, and then when she did, he admired her strength.
Mayor Rudolph W. Giuliani, who had often visited her at her bedside while she was in the hospital, married them in his Times Square office. She wore a blue dress and pearls. While she was pregnant, in a burst of creativity, she and her friends recorded "While We're Young," an album of children's songs that she had written before the attack, including the song "Moving." Her ex-boyfriend, Mr. Scherr, produced the CD. On it, her husband plays drums and she plays electric piano.
Is her life as it was? Not exactly, though she is reluctant to attribute the differences to her injuries. Her last two piano students left her, without calling to explain why, she said. She has resumed playing classical music, but simple pieces, because her daughter does not give her time to practice. As for jazz, "I don't even try," she said. She would like to drive more, feeling stranded in the suburbs, but she is easily rattled. She tries to be content with staying home and caring for her daughter.
Dr. Ghajar, a clinical professor of neurological surgery at what is now called New York-Presbyterian Hospital/Weill Cornell Medical Center, who operated on Ms. Kevorkian McCann after the attack, said last week that her level of recovery was rare. "She's basically normal," he said. Other experts, who are not personally familiar with Ms. Kevorkian McCann's case, are more cautious. Regaining the ability to play the piano may involve an almost mechanical process, a semiautomatic recall of what the fingers need to do, said Dr. Yehuda Ben-Yishay, a professor of clinical rehabilitation medicine at New York University School of Medicine. "Once brain-injured, you are always brain-injured, for the rest of your life," Dr. Ben-Yishay said. "There is no cure, there is only intensive compensation." The more telling part of a recovery, in his view, is psychological, and on that score he counts Ms. Kevorkian McCann's marriage and child as a significant victory.
For her part, the piano teacher knows she has changed, but she has made her peace with it. "I was sort of a hyper —— I don't know if I was a Type A, but I was ambitious," she says. "Why was I so ambitious? I was a piano teacher. I don't know what the ambition was about. I really did come back to the person I'm supposed to be."
TV Screen, Not Couch, Is Required for This Session
Kirk Johnson, New York Times- 6/8/2006
FLAGSTAFF, Ariz. — Dr. Sara Gibson looked into the television screen and got right down to it. "What's keeping you alive at this point?" she asked her patient, a middle-aged woman who asked to be identified only as D. D grimaced, looked down, then to the side and finally into Dr. Gibson's face, which filled the screen before her in a tiny clinic three hours east of here in the Arizona desert. "Nothing," said D, who Dr. Gibson says suffers from bipolar disorder and post-traumatic stress from the sexual abuse she suffered as a child.
It is Wednesday in the hinterlands of rural Arizona, and the psychiatrist is in. Sort of. Actually, Dr. Gibson was here in Flagstaff in a closet-size office of a nonprofit medical group, with a pale blue sheet behind her as a backdrop and a cup of tea at her side. She is one of a growing number of psychiatrists practicing through the airwaves and wires of telemedicine, as remote doctoring is known.
Psychiatry, especially in rural swaths of the nation that also often have deep social problems like poverty and drug abuse, is emerging as one of the most promising expressions of telemedicine. At least 18 states, up from only a handful a few years ago, now pay for some telemedicine care under their Medicaid programs, and at least eight specifically include psychiatry, according to the National Association of State Medicaid Directors. Six states, including California, require private insurers to reimburse patients for telepsychiatry, according to the National Conference of State Legislatures.
Growing prison populations have a lot to do with the trend. Since reimbursement for prison care is easy and safety issues for doctors are significant, many telemedicine programs, notably an ambitious one in Texas, started there. Now, the falling price of technology is making care available to far-flung rural residents like D.
Dr. Gibson rides a disembodied circuit through this terrain. On Wednesdays, she sees patients in the tiny community of Springerville near the New Mexico border through a firewalled T1 data line, and on Thursdays in St. Johns. Each side of the exchange has its own television-mounted camera, angled so that doctor and patient can maintain the illusion of looking into each other's eyes in real time. And so, through illusion and delusion, depression, anxiety, paranoia — and here and there a laugh or two — a day in the life of a rural telepsychiatrist and her patients unfolded. "Is there self-harm going on, too?" Dr. Gibson pressed D, typing notes into the computer and glancing back at the screen. D paused, then quietly said, "Yeah."
Dr. Gibson, 44, was a pioneer in the field. She has been seeing patients only this way for 10 years and is still one of a handful of doctors in the country who practice telepsychiatry exclusively. Her territory is Apache County, which is about the size of Massachusetts and Connecticut combined, but which lacks even a single psychiatrist on the ground for its 69,000 residents despite widespread problems of poverty, drug use, child abuse and a suicide rate that is twice the national average.
The American Psychiatric Association says on its Web site that it supports telemedicine, "to the extent that its use is in the best interest of the patient," and practitioners meet the rules about ethics and confidentiality. But in places like Apache County, where the alternative is no treatment at all, most mental health workers say that every new wire and screen is to be deeply cheered. "Basically, doctors can do, surprisingly, almost everything," said Don McBeath, the director of telemedicine and rural health at the Texas Tech University Health Sciences Center in Lubbock. "The difference is they can't touch you or smell you."
Dr. Gibson said the lack of smelling and touching, at least when it comes to psychiatry, has proved to be a good thing. Being physically in the presence of another human being, she said, can be overwhelming, with an avalanche of sensory data that can distract patient and doctor alike without either being aware of it. "Initially we all said, 'Well, of course it would be better to be there in person,' " she said. "But some people with trauma, or who have been abused, are actually more comfortable. I'm less intimidating at a distance."
Some of the doctor's patients, who agreed to allow a reporter and photographer to observe their therapy sessions over two recent days — one day in Flagstaff with Dr. Gibson, the second day in a field clinic in St. Johns, population 3,000 — said they were in fact perfectly happy with the doctor's being hundreds of miles away, though some were quick to add that no offense was intended. "Some people don't want to have to deal with a real person," said one patient, a 63-year-old woman who has dementia and bipolar disorder.
One thing Dr. Gibson has learned over the years is that she should not wear stripes or zigzag patterns, which can look strange on television, especially to already disturbed people. For patients with paranoia, she regularly pans the camera around her little room to prove that no one else is lurking and listening. (A white-noise machine purrs outside Dr. Gibson's office door, muting the exchanges within, and no session is ever recorded.) She worries, sometimes, about the children she sees, almost all of whom immediately and enthusiastically embrace the idea of a talking to the nice, chatty woman on the television. "Do they understand that the TV doesn't always talk to them?" Dr. Gibson said.
Another patient, Mike Kueneman, who allowed his full name to be used, has seen Dr. Gibson for about five years, through the periods with the voices in his head and what he calls the "psychotic episode" that landed him in jail this year on burglary charges. Mr. Kueneman said he felt more comfortable with Dr. Gibson, even though they have never met in person, than he does with most of the people he knows. Like most of Dr. Gibson's patients, he pays little or nothing to see her. State programs for low-income and mentally ill people pay for the $120 psychiatric evaluations and $40 follow-up visits — and for the medicines she prescribes, which can cost thousands of dollars. "It's hard for me to trust any other doctor," said Mr. Kueneman, who attended a telesession in the St. Johns clinic in leg shackles and handcuffs, accompanied by an Apache County sheriff's deputy.
Some things did not happen as expected. Dr. Gibson predicted, for example, that at least one patient would incorporate the teleconferencing technology into his or her delusions and come to believe that telemedicine could be used to read people's thoughts or get inside their heads. To the contrary, in matters of the psyche — two people in two rooms looking at each other across a cool electronic medium — it is still all about human connection. "I just feel like she's here," said a 24-year-old mother of three who asked to be referred to as C. C was struggling with depression, anxiety and fantasies of suicide. "I sometimes forget we're not in the same room." Dr. Gibson spoke up from her room in Flagstaff: "That's funny, I would say that I feel the same way."
Dr. Gibson and C have known each other across the telewaves since C became a single mother on her own at age 17. The emotions ran deep as they spoke and C described the dark thoughts that sometimes come at night. Gripped by insomnia, convinced that someone else is in the trailer she lives in, her mind races, she said, and the fantasy rolls out of how she might take her youngest child with her and disappear, driving off into the night. "I don't want you killing yourself," Dr. Gibson said with a matter-of-fact tone. "So that means talking."
Apache County had a genuine, in-the-flesh psychiatrist once, Dr. Julia Martin, who practiced there for about 10 years until her retirement in 1996. Dr. Martin was trained as a pediatrician and went back to school for psychiatry in her 50's. For more than a decade, she was it, the county's solo psychiatrist and also the only one serving the nearby Fort Apache Indian Reservation. "You did get to know your patients pretty well — sometimes better than you'd like," Dr. Martin, 74, said in a telephone interview from her home in a remote corner of the county. Sometimes people would show up in the middle of the night, she said, desperate to see her. Other times, they delivered brownies.
What Dr. Gibson's patients imagine of her life and what she is like when she is not on camera is unknown. She sometimes mentions her children to them, and her passions for music and singing. She speculated that telemedicine has probably in some ways amplified and enlarged her image in the minds of some patients — that if she is on television she must be really important, larger than life. She has been to Apache County once, for a "meet the psychiatrist" event in St. Johns years ago. Many of the patients who showed up remarked, she said, about how much shorter she was than they had expected.
Detox Clinic Opening for Video Addicts
Associated Press, 6/9/2006
AMSTERDAM, Netherlands -- An addiction center is opening Europe's first detox clinic for game addicts, offering in-house treatment for people who can't leave their joysticks alone. Video games may look innocent, but they can be as addictive as gambling or drugs -- and just as hard to kick, says Keith Bakker, director of Amsterdam-based Smith & Jones Addiction Consultants.
Bakker already has treated 20 video game addicts, aged 13 to 30, since January. Some show withdrawal symptoms, such as shaking and sweating, when they look at a computer. His detox program begins in July. It will run four to eight weeks, including discussions with therapists and efforts to build patients' interests in alternative activities. ''We have kids who don't know how to communicate with people face-to-face because they've spent the last three years talking to somebody in Korea through a computer,'' Bakker said. ''Their social network has completely disappeared.'' It can start with a Game Boy, perhaps given by parents hoping to keep their children occupied but away from the television. From there it can progress to multilevel games that aren't made to be won. Bakker said he has seen signs of addiction in children as young as 8.
Hyke van der Heijden, 28, a graduate of the Amsterdam program, started playing video games 20 years ago. By the time he was in college he was gaming about 14 hours a day and using drugs to play longer. ''For me, one joint would never be enough, or five minutes of gaming would never be enough,'' he said. ''I would just keep going until I crashed out.'' Van der Heijden first went to Smith & Jones for drug addiction in October 2005, but realized the gaming was the real problem. Since undergoing treatment, he has distanced himself from his smoking and gaming friends. He says he has been drug- and game-free for eight months.
Like other addicts, Bakker said, gamers are often trying to escape personal problems. When they play, their brains produce endorphins, giving them a high similar to that experienced by gamblers or drug addicts. Gamers' responses to questions even mirror those of alcoholics and gamblers when asked about use. ''Many of these kids believe that when they sit down, they're going to play two games and then do their homework,'' he said. However, unlike other addicts, most gamers received their first game from their parents. ''Because it's so new, parents don't see that this is something that can be dangerous,'' Bakker said.
Tim, a gamer who is currently under treatment, agreed to discuss his addiction on condition of his last name not being used. He said he began playing video games three years ago at age 18. Soon he wouldn't leave his room for dinner. Later, he began taking drugs to stay awake and play longer. Finally he sought help and picked up other hobbies to occupy his time.
Symptoms of addiction are easy to spot, Bakker says. Parents should take notice if a child neglects usual activities, spends several hours at a time with the computer and has no social life. Bakker said parents of game addicts frequently echo the words of partners of cocaine addicts: '''I knew something was wrong, but I didn't know what it was.'''
Hispanic Kids More Prone to Suicide
Associated Press, 6/9/2006
ATLANTA -- Hispanic high school students use drugs and attempt suicide at far higher rates than their white and black classmates, says a new federal survey that has the experts somewhat perplexed. More than 11 percent of all Latino students -- and 15 percent of Latino girls -- said they had attempted suicide, according to the report issued Thursday by the U.S. Centers for Disease Control and Prevention. The white and black rates were about 7.5 percent. Latinos also reported much higher rates of using cocaine, heroin, ecstasy and methamphetamines; their use of condoms was at lower rates than the other population groups. ''We really don't understand this phenomenon as well as we should,'' said Dr. Glenn Flores of the Medical College of Wisconsin, who spoke at a CDC news conference.
The CDC survey of nearly 14,000 U.S. high school students has been conducted every other year, since 1991. Results reported Thursday were from last year's survey. Questionnaires go to students in grades 9-12 in public and private high schools in all 50 states and the District of Columbia. Researchers got parental permission for each student who participated.
Adolescents cannot always be counted on to tell the truth about their sexual exploits, drug use, or other risky behaviors. But officials took many steps to ensure accurate responses, said Howell Wechsler, the director of the CDC's Division of Adolescent and School Health. Participation was confidential, kids were spaced apart when answering the questions, teachers did not hover, and the questionnaire was designed so everyone would finish at about the same time -- no matter how risky or safe their behavior, Wechsler said. ''We have every confidence if there's any lying going on, it's extremely negligible,'' he said.
The report contained some good news. Only 10 percent of high school students said they never or rarely wore a seat belt while riding in a car, down from 18 percent in 2003. But the percentage of students who said they had smoked in the last month rose slightly -- 23 percent, up from about 22 percent in 2003. Also, there was no decline in the percentage of students who said they'd had sexual intercourse, which held steady at 47 percent, or in the percentage of sexually active students who said they'd used a condom, which was 63 percent.
However, it's the first time in 14 years that condom use among sexually active high school students has not risen, noted Martha Kempner, spokeswoman for the Sexuality Information and Education Council of the United States, a New York-based nonprofit group. ''It calls into question the federal government's investment in abstinence-only-until-marriage programs, many of which openly discourage condom use,'' she said.
Black students reported the most sexual activity, the most TV-watching and the highest use of video or computer games. White kids were the most frequent smokers and heavy drinkers, and were worst about eating enough fruits and vegetables.
But Hispanic students had other problems. About 36 percent of Hispanics reported prolonged feelings of sadness or hopelessness, slightly higher than previous years. In contrast, about 28.5 percent of black students reported such feelings in the 2005 survey, about the same as two previous surveys. And about 26 percent of white students reported such feelings, down slightly from 2003 and 2001.
In the category of drug use, 1 in 8 Latino students said they had done cocaine, 1 in 10 had done ecstasy, 1 in 11 methamphetamines and 1 in 28 heroin. Hispanics reported much higher rates of drug use in previous surveys, and that hasn't changed. The enduring disparity is concerning, said Flores, director of the Medical College of Wisconsin's Center for the Advancement of Underserved Children. He noted that substance abuse is higher in Hispanic kids who are more at home with American culture. ''It's unclear why that is, but we need to understand that better because then we can learn how we can protect all of our youth,'' he said.
Access to Treatment Lowers Drug-Related Deaths
David Brown, Washington Post- 6/9/2006
The number of drug-overdose deaths in Baltimore has fallen to the lowest level in 10 years, the apparent result of a huge effort by the city to make drug treatment readily available and to give addicts the capability to reverse some overdoses themselves.
In 2005, 218 people died of "drug intoxication" in the city, down from about 235 in 1996, and one-third below the peak of 328 in 1999, according to data collected by Maryland's chief medical examiner and presented at a drug-treatment conference yesterday in Baltimore. About 90 percent of deaths each year are from heroin and other opiate overdoses.
In the past decade, the city's slots for drug treatment for uninsured or under-insured residents rose 62 percent, from 5,136 to 8,295. Funding for drug treatment nearly tripled, from $18 million in 1996 to $53 million last year. In 2005, 23,000 people received drug treatment in publicly supported clinics -- a total of about 28,000 "treatment episodes."
A study released in January 2002 compared the experience of nearly 1,000 addicts the year before and the year after treatment. One year after treatment, there was a 69 percent reduction in heroin use, a 48 percent reduction in cocaine use, a 69 percent reduction in getting income by illegal means, and a 38 percent reduction in imprisonment.
In the past 10 years, the city has also seen downward trends in numerous other problems related to drug abuse, including emergency room visits related to cocaine and heroin use; homicides; violent crimes; property crimes; HIV infections linked to injected drugs; and rates of syphilis and gonorrhea.
Joshua M. Sharfstein, Baltimore's health commissioner, said a crucial element in gaining more money for treatment from the city and state governments was the argument that drug abuse was dragging down the entire city, not just its poor and addicted residents.
"People realized it was not only good health care, it would also help move the city forward. It makes the city safe, it stems the flight of people out of Baltimore, and I think it worked," he said.
About $9 million, used for both treatment and advocacy, came from the Open Society Institute, a foundation underwritten by billionaire currency trader George Soros. He said yesterday that he will spend an additional $10 million to help the city maintain its gains and will spend as much as $10 million elsewhere in the country to help other jurisdictions start similar programs.
"It really has produced tangible results," he said during a break between presentations at the two-day conference on public drug-treatment systems at Johns Hopkins University's Bloomberg School of Public Health. "It has been very successful in showing that there are alternative ways of dealing with the drug issue other than through incarceration."
Over the past eight years, his foundation has spent about $50 million in Baltimore to expand addiction treatment, reduce the social and economic costs of incarceration, boost the academic success of inner-city children, and foster local organizations and activists.
Baltimore developed an addiction epidemic in the late 1980s and early 1990s.
Heroin-related emergency room visits doubled from 1990 to 1991, and by 1996 the city had the highest rate of drug-related ER visits in the country. Seventy-five percent of its violent and property crimes were believed to be related to drug use or the drug trade. AIDS became the leading cause of death among black men and the second-leading cause among black women, with most of the infections acquired through drug use.
Two local foundations -- Abell and Weinberg -- called for more government investment in drug treatment and invested some of their own money.
Over the years, the city adopted controversial and innovative strategies. It began needle exchange for addicts in 1994. In the past two years, it has trained nearly 1,600 addicts and their loved ones how to do CPR and use naloxone (Narcan), an injected medicine that rapidly reverses opiate overdoses. As of the end of last year, 194 overdoses had been aborted, according to the data presented yesterday.
Soros, who is Hungarian by birth and lives in New York, had no connection to Baltimore before he chose it as a test site for investing in various social and economic policies he supports. New Haven, Conn., was the other place he considered.
Kurt L. Schmoke, a former prosecutor who was elected mayor of Baltimore in 1987, gained national attention when he advocated decriminalization of illicit drugs in a 1988 speech to the U.S. Conference of Mayors. Over his three terms in office, he became a leading advocate for the view that drug addiction should be viewed as a health problem, not a criminal problem.
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